Project Summary: The Bureau of Maternal, Infant and Reproductive Health (BMIRH) of the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) is requesting assistance from the CDC to continue the Pregnancy Risk Assessment Monitoring System (PRAMS) in NYC. PRAMS is an ongoing, population-based risk factor surveillance system designed to identify and monitor selected maternal experiences and behaviors before, during, and shortly after pregnancy. PRAMS is conducted in a stratified random sample of mothers delivering a live birth in NYC. It presently exists in 37 states and NYC, and represents 75% of births in the US. A standard protocol and survey methodology are used thus allowing comparisons across participating sites. The goals of BMIRH are to: 1) improve adolescent sexual and reproductive health, 2) make breastfeeding the norm in NYC, and 3) improve maternal and infant health outcomes for low- income families. Since its implementation in 2001, PRAMS has been a unique source of information on these and related maternal, infant and reproductive health topics in NYC. PRAMS provides information on the prevalence of behaviors and experiences that are associated with poor pregnancy outcomes. The linking of PRAMS and birth certificate data allows an increased understanding of how these risk factors contribute to poor pregnancy outcomes in NYC. In NYC each month ~180 women who gave birth in the previous 2-4 months are randomly selected from birth certificate records to participate in PRAMS. Women who give birth to low birth weight infants (<2,500 grams) are oversampled. PRAMS uses a mixed mode of data collection, with mail surveys as the primary method. As an incentive, all women are sent a Metrocard with the first mailing of the survey. Women receive up to three mailings of the survey in English, Spanish, or Chinese. Women who do not return the mail survey are contacted by telephone. The data collection cycle for each monthly sample lasts up to 95 days. PRAMS data are weighted to represent all women who give birth in NYC during the year. The analytic dataset includes data from the questionnaire and selected birth certificate variables. PRAMS data have, and will continue to, inform NYC's priorities related to improving the health of women and children, and its choice of programs, policies and activities toward that end.